Thursday, August 11, 2011

Now who would have thought: Walking is as good for the legs (PAD) as it is for the heart.

Evening Stroll Walks Off PAD Risk

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: August 10, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

A lifetime of even light exercise protects the heart but also the legs, according to a study showing reduced risk of peripheral arterial disease (PAD).

A sedentary lifestyle predicted 46% higher risk of peripheral arterial disease compared with a lifetime of recreational activity of any intensity (P=0.044), John P. Cooke, MD, PhD, of Stanford University Medical Center in Stanford, Calif., and colleagues found.

The biggest incremental gain in PAD protection was going from essentially no activity to minimal activity, though more activity was more protective, the group reported online in the Journal of Vascular Surgery.

"Even light activity, such as strolling, is enough to protect against peripheral arterial disease," Cooke told MedPage Today in an interview.
Action Points  
  • Explain that a lifetime of even light exercise protects the heart but also the legs, according to a study showing reduced risk of peripheral arterial disease.
  • Note that the biggest incremental gain in peripheral arterial disease protection was going from essentially no activity to minimal activity, though more activity was more protective.
The current recommendations for about 30 minutes of exercise on a regular basis to protect against cardiovascular disease would certainly help prevent peripheral arterial disease as well, he noted.

"Get up off the couch, go for a walk, and you will be less likely to have problems in the future," Cooke urged.

Physicians should take these results as one more reason to recommend an active lifestyle to their patients but should also heighten clinical suspicion for peripheral arterial disease when they know patients are sedentary, the researchers noted.

Once people get peripheral arterial disease, the pain from claudication may limit activity.
The researchers looked at lifetime recreational activity in the National Heart, Lung and Blood Institute's observational Genetic Determinants of Peripheral Arterial Disease study.

Among 1,381 patients who came in for elective coronary angiography at two centers in the study, 30% reported being entirely sedentary with no lifetime recreational activity.

Inactive individuals were nearly twice as likely overall to have peripheral arterial disease as participants who reported the most active lives (25.6% versus 13.7%, P=0.001).
Prevalence of peripheral arterial disease was intermediate in the three intermediate quartiles of activity, with little difference among them at 15.8% to 17%.


After adjustment for other risk factors, lifetime recreational activity significantly predicted prevalence of peripheral arterial disease overall (13.7% versus 25.6% no activity), and a better ankle-brachial index (1.02 versus 0.94). The P value for both was less than 0.001.
Cooke's group called the link all the more remarkable because the entire study population was already at high risk for atherosclerosis, for which they were undergoing diagnostic coronary angiography.

Other independent predictors of peripheral arterial disease included higher fasting glucose, female gender, tobacco use, older age, lower kidney function, triglyceride level, and lower body mass index.

While the observational study couldn't determine causality, the investigators suggested possible ways that exercise could stave off peripheral arterial disease.

"Exercise may enhance endothelial function, by upregulating vasoprotective pathways such as heme oxygenase, superoxide dismutase, and nitric oxide synthase, and by downregulating the expression of proteins mediating vascular inflammation and thrombosis," they wrote.
Other possibilities are better microcirculatory function and endogenous fibrinolysis and reduced age-related arterial stiffness, the group added.

They cautioned, though, that the study may have been subject to recall bias if recent symptoms dampened recall of lifetime exercise, although that likely wasn't the case because exercise-induced leg pain didn't correlate with lifetime or recent recreational activity .

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